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Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.
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Breast reduction surgery is a procedure to reduce the size of the breast. The surgery is usually performed on women with overly large, pendulous breasts who are experiencing one or more of the following:
Breast reduction surgery relieves these problems by removing some of the breast fat, glandular tissue, and skin, making the breast smaller, lighter, and firmer. The areola, the darker skin around the nipple, can also be made smaller.
We want to make sure that you understand the procedure and have realistic expectations. There are trade-offs and risks associated with this procedure. Trade-offs are those things you expect to happen and are willing to accept in order to get the benefits of the procedure. They include:
If you cannot accept these trade-offs, we recommend that you not have this procedure. In addition, risks of the procedure or possible complications include:
This procedure often helps women pursue activities they were unable to participate in previously.
To ensure a successful procedure, we require the following before you undergo surgery:
There may be other requirements based on your individual situation and needs.
Pregnancy and breastfeeding
You may want to delay breast reduction if you are considering child bearing and breastfeeding. Your breast may change size and shape if you become pregnant, and it is possible to lose the ability to breastfeed with breast reduction.
We perform breast reduction surgery while you are under general anesthesia. You will be asleep throughout the entire surgery. The techniques for this surgery vary, but all include an incision and scar around the areola.
One of the most common procedures involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breasts. We remove glandular tissue, fat, and skin and move the nipple and areola into their new position. Then the skin from both sides of the breast is brought down and around the areola, creating the new shape of the breast. In most cases, the nipples remain attached to their blood vessels and nerves. However, if your breast is very large or pendulous, the nipples and areolas may have to be completely removed and grafted to a higher position. Grafting always results in the loss of sensation in the nipple and areola area.
There are several other techniques for this surgery. A circular pattern around the areola or a keyhole pattern around the areola and vertically down to the breast crease are some variations. We will work with you to determine the best approach, taking into consideration your health, breast composition, amount of reduction desired, and personal preferences.
Breast reduction is not a simple operation, but it is normally safe. As with any surgery, there is the possibility of complications. You can reduce your risk of developing complications by closely following our advice both before and after surgery.
Poor wound healing is the most common complication of breast reduction surgery. It may result in the following:
Some bleeding is normal. Your body can absorb a small amount of blood, and we often use drains to manage the bleeding. In rare instances, you may experience swollen, painful breasts. This is an emergency, and you need to be seen and evaluated by us.
Fat necrosis is the death of fatty breast tissue. This tissue loss can result in significant loss of volume in the breast and asymmetry of size, shape and appearance. It is more common in individuals who are overweight, smoke, or have medical problems.
Keloids are large thick, sometimes painful, scars.
Breast asymmetry is very common. Your breasts will not be identical after a breast reduction surgery.
Infection is very rare and is usually associated with wound-healing problems.
After your surgery, you will need to limit some of your activities. Following these limits decreases your risk of developing complications, such as poor wound healing and excessive bleeding. These activity limitations include:
Scar development is a process that lasts up to a year or more after surgery. Scarring can be significant, but with a little care, the appearance of the scars can improve. It is also common to have areas of numbness in your breasts. This may be permanent, but some patients experience improvement with time.
As healing progresses, itching can become significant. Remember, itching equals healing. Sometimes the itching will come from deep inside where no amount of scratching will help, or the nipple can itch a great deal. Be very careful not to damage tender new skin.
Cooling the breasts can soothe them. You can do this with cool air, a cool shower, or ice packs (the blue gel ones are very good because they conform to the breast nicely, are lightweight, and can be reused). When using ice packs, lay a thin towel over the breasts, then the packs, fold the towel over the packs, and gently hug them to your body. Generally, it is a good idea to use the ice packs no more than 15 minutes at a time.
For the first year, avoid sunlight on your scars to keep the areas from developing a darker pigment than your surrounding skin. Use clothing and sunscreen to protect the scars.
Scar tissue does not have the same lubrication glands as regular skin. After 3 weeks post surgery, you can help your scars by keeping them moisturized with lotion or ointment. Massage the length of the scar with a firm circular motion 2 to 3 times a day. This will help organize the scar tissue and help it to be more mobile and soft.
You may notice increased redness in your scars between 3 to 6 months after surgery. This is normal.
If your scars are growing thick or ropelike, are spreading outside their original boundaries, or are itchy, burning, and painful, please call the clinic. If you have a history of keloids or hypertrophic scars, please discuss this with us.
It may take you a few weeks to become comfortable with your new figure. Your stomach may seem more prominent than before the surgery. It is common to question the decision to have breast surgery and to have temporary regrets in the immediate postoperative period. Usually by 6 to 8 weeks after surgery, most women become comfortable with the new size of their breasts and begin to enjoy the benefits of having smaller breasts.
Plan to be off work for 2 to 6 weeks, depending on the type of work you do and your recovery. Arrange for childcare, grocery shopping, transportation, and general support during your recovery.
You will need someone to drive you home and stay with you at least for your first night at home.
Purchase a sports bra with the following features:
Stop all nonsteroidal anti-inflammatory medications (prescription and over-the-counter) 2 weeks before surgery. These include aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), and several arthritis medications. If you are taking a low-dose aspirin, stop it 2 weeks before surgery.
You may feel anxious around the time of surgery. This is a normal response to any kind of stress. You may experience a range of physical as well as emotional changes, such as feelings of restlessness, agitation, and irritability. You may have emotional outbursts or tearfulness. As your surgery approaches, you may need additional reassurance. It is important for you to be kind and patient with yourself. Being aware and prepared for the possibility of these feelings can lessen any fearfulness that may arise.
It is important for you to get up, move around the house, and take some deep breaths 4 to 6 times a day. Plan to sleep on your back with your head elevated, if possible. Some people experience a slight sore throat or mild cough for 2 to 3 days after surgery. This is a side effect of anesthesia and should resolve in 48 to 72 hours.
You will be the most uncomfortable the first night and day after surgery. Your pain will stabilize over the next 24 to 48 hours and then decrease each day. You may be able to discontinue prescription pain relievers by the end of the first week. Some people take only a few doses and then use Tylenol. It is important to listen to your body and take medication as you need it. You will heal faster if you are not tense and tired from pain. Pain is also your body's way of asking you to slow down. Plan to rest during the first week after surgery.
We will prescribe a stronger pain reliever for use after surgery. It is usually a combination of acetaminophen (Tylenol) and a narcotic. We recommend that you:
Narcotics will interact with alcohol, so do not drink at the same time you are taking the medication. The medication will also make you drowsy, so do not drive while you are taking it. After the first few days, if you have stopped taking pain medication, you may drink.
Drains are used in 80 to 90 percent of our surgeries to prevent postoperative swelling and fluid buildup. You will be instructed in drain care before leaving the hospital.
Keeping your upper body quiet in the first few days after surgery will reduce your drainage.
You will not need to change a clean dry dressing for the first 2 to 3 days after surgery. If you have drains, your first dressing change will take place in our clinic. If you do not have drains, we may direct you to remove your dressings at home after surgery.
We will give any other wound care instructions to you at the time of your surgery.
Please call or come into the clinic or to the Emergency Department when the clinic is closed as soon as possible if you have:
Your personal physician will request a plastic surgery consultation for you for breast reduction surgery. You can be scheduled for an initial consultation with us if you meet the criteria necessary for a medically indicated breast reduction surgery.
Your first meeting with us is usually a 30- to 45-minute consultation. I will address your questions and concerns, review your reasons for considering breast reduction, and assist you with making the best decision for you.
I will take measurements and perform a physical exam. We will discuss the procedure and risks involved. I will make recommendations to help you reach your goal.
You may be asked to complete a medical history questionnaire, which will include your:
If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.
If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need.
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
If refills are needed in the future, you can:
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.
If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.
As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available at any time that is most convenient for you. From my home page you can:
• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.
• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.
• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.